Findings of Universal Cystoscopy at Incontinence Surgery and their Sequelae Journal Article

Authors: Zyczynski, H. M.; Sirls, L. T.; Greer, W. J.; Rahn, D. D.; Casiano, E.; Norton, P.; Kim, H. Y.; Brubaker, L
Article Title: Findings of Universal Cystoscopy at Incontinence Surgery and their Sequelae
Abstract: OBJECTIVE: To report the frequency of abnormal cystoscopy at incontinence surgery and identify risk factors and sequelae of injury. STUDY DESIGN: Findings of cystoscopy were prospectively collected in 3 multicenter surgical trials. Clinical, demographic, procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and non-injury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months post-procedure were assessed. RESULTS: Abnormal findings in the bladder or urethra were identified in 95 of 1,830 (5.2%) women. Most injuries were iatrogenic (75.8%). Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral slings (MUS) (6.4% each), followed by autologous pubovaginal slings (PVS) (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 v. 51.9 years; p=0.04), vaginal deliveries (3.2 vs. 2.6, p=0.04), and blood loss (393 vs. 218 ml, p=0.01) were associated with LUT injury during retropubic urethropexy, but only age (62.9 vs 51.4 yrs, p=0.02) and smoking history (p=0.04) were associated for PVS. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, prior incontinence surgery, concomitant procedures, anesthesia type and trainee participation did not increase LUT injury frequency. Though discharge with an indwelling catheter was more common after trocar perforation compared to the non-injury group (55.6% vs. 18.5%, p 0.001), they did not differ in overall success, voiding dysfunction, recurrent UTIs or urge urinary incontinence. CONCLUSION: Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations addressed intraoperatively have no long-term adverse sequelae.
Journal Title: American Journal of Obstetrics and Gynecology
Volume: 210
Issue: 5
ISSN: 1097-6868; 0002-9378
Publisher: Unknown  
Date Published: 2014
Start Page: 480.e1-8
Language: ENG
Notes: CI: Copyright (c) 2013; JID: 0370476; OTO: NOTNLM; 2013/09/03 [received]; 2013/11/24 [revised]; 2013/12/27 [accepted]; aheadofprint